Table of Contents page I. Introduction and Goals... 2

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1 Final Report, Targeted State MCH Oral Health Service Systems Grant Maine CDC Oral Health Program, Maine Department of Health & Human Services Grant #H47MC08655 Oral Health Program Tel. (207) Fax (207) Table of Contents page I. Introduction and Goals... 2 II. Outcomes by Objective... 3 Objective 1. Create an advisory group for the implementation of the Kids Oral Health Partnership 3 Objective 2. Review and expand the existing curriculum in areas relating to children with special health care needs 3 Objective 3. Review and adapt the curriculum as needed to achieve cultural competency 4 Objective 4. Implement and coordinate trainings using the KOHP curriculum with non-dental professionals 4 Objective 5. Develop and implement an evaluation component to determine use of curriculum and increased oral health visits, including the identification of a dental home 7 Objective 6. Develop and implement public health education and oral health communications components that promote early dental visits and early intervention 7 Objective 7. Enhance referral opportunities and networks 8 III. Sustaining the Work... 9 Appendix. Final Evaluation Report

2 Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 I. Introduction and Goals Maine s Targeted State MCH Oral Health Service Systems grant, originally titled the Maine Preventive Oral Health Partnerships Project, was designed to support the Maine Title V Program s priority for oral health: to foster conditions to improve oral health services and supports for the MCH population. The Project was conceptualized in congruence with the Maternal and Child Health Bureau s (MCHB) intent to support the State s capacity to expand preventive and restorative oral health service programs for Medicaid and State Children's Health Insurance Program (SCHIP) eligible children, and other underserved children and their families. As the program was instituted it was renamed the Kids Oral Health Partnership (KOHP) and the primary focus became the provision of training on oral health to providers who serve very young children. We developed and tested training models, developed pre-, post and follow-up surveys, and instituted trainings across the state. We marketed the Partnership through conferences, meetings, e-news, web sites, brochures, flyers, our advisory committee, and increasingly over time through word of mouth. In the end we trained over 1750 people in how to assess oral health, provide oral health guidance, employ prevention strategies, and refer to dentists. We worked with Head Start, Early Head Start, WIC, Home Visitors, From the First Tooth ( a privately funded initiative devoted to instituting fluoride varnish in pediatric practices as well as medical and dental professional associations and a variety of medical and dental practices. The partnerships and relationships that have been established remain strong, and will continue to contribute to increasing oral health care for children younger than age 3 in both formal and informal ways. A narrative of our accomplishments, by objectives, follows. Our three over-arching goals for the Project were to: 1. Educate, build awareness and integrate oral health into existing health delivery systems 2. Enable non-dental providers to better recognize and understand oral diseases and conditions 3. Enable non-dental providers to better engage in anticipatory guidance, preventive interventions, and appropriate referral for improved oral health and oral health access Page 2

3 II. Outcomes by Objective Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 Objective 1. Create an advisory group for the implementation of the Kids Oral Health Partnership and integration of its work with existing bodies such as the Maine Dental Access Coalition, member organizations, and other collaborating organizations. Summary of outcomes/accomplishments: The Advisory Committee members contributed advice and connections throughout the length of the project. We continued to build our membership over the four years of the project as collaborative opportunities arose. During the past year the advisors played an important role in planning the May conference, Oral Health for Young Children: Everybody s Business. Although the federal funding for training has ended, the Kids Oral Health Partnership will continue, and we expect that this body will evolve in its purpose and membership as succeeding projects addressing children s oral health develop. Impact on System of Care: Insofar as the Advisory Committee members brought an increased attention to oral health back to their professional settings, the Committee may have had an impact to the system of care. The May conference represented a significant step in bringing a broad variety of professionals who work with young children together on behalf of the oral health of young children and providing opportunities for lasting relationship building. Lessons learned: The Advisory Committee was a good method of engaging a broad set of stakeholders, some of whom are key players in other health delivery systems and partner programs. Objective 2. Review and expand the existing curriculum in areas relating to children with special health care needs (CSHN). Summary of outcomes/accomplishments: Material on CSHN was incorporated into the training curriculum and resources for parents and providers for this population were featured in the KOHP Partnership e-news and continue to be posted on the KOHP web site. Impact on System of Care: This objective had a minimal impact on the system of care. We provided exposure to the problem of CSHN and training opportunities for all trainees to learn more about the issue. However, we were not able generate engagement with either child care providers or medical providers around this issue, as described below, nor were we able to generate engagement from the CSHN community. Lessons learned: In our original application we included another objective relating to increasing referral networks and services for CSHN. We eliminated this objective this after making a number of efforts to influence this problem. We consistently offered follow-up training on serving special needs children at each KOHP training but did not receive any requests. Although we had a member of the Maine Parent Federation as one of our advisors, and she actively sought Page 3

4 Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 to have KOHP present at their annual meeting, we were not successful due to competing priorities of the Federation. We also attempted, unsuccessfully, to be included in a series of focus groups with parents of CSHN conducted by the Children with Special Health Needs Program of the Division of Family Health. We also attempted to join a work group of Medicaid officials addressing CSHN, but discovered it is a national group limited to Medicaid Programs only at this time. We were successful in cross linking web sites with the ME CDC s Division of Family Health Children with Special Health Needs Program. The Program Director, who is also a KOHP advisor, told us that the parents of CSHN who know how to advocate for their children are successful in getting in to see one of the small number of Maine s pediatric dentists, and willing to travel far distances to do so. There are also many parents who don t recognize the need for oral health services for their children, or who don t know how to access the system to get help. When parents contact the CSHN Program for help in finding a dentist, the problem is not in finding dentists that treat special needs; it s a problem finding a dentist who accepts MaineCare (Maine s Medicaid Program), which is a problem throughout the state, regardless of health status. All of Maine s 14 pediatric dentists do serve children with special needs and children receiving MaineCare. Objective 3. Review and adapt the curriculum as needed to achieve cultural competency. Summary of outcomes/accomplishments. Our Advisory Committee included the Director of the ME CDC s Office of Minority Health who, among others, reviewed the curriculum for cultural competency and suggestions from that process were incorporated. Impact on System of Care. This process, although necessary and helpful, could not be said to impact the system of care. However, we did train providers working with substantial minority communities where there was discussion of different cultural habits and practices, and we were able to point them to translated oral health materials. Lessons learned. The project design and scope did not allow for addressing different cultural attitudes and values in a deep or comprehensive manner. A better approach would probably be one which originates from the provider and focuses on a specific cultural community and looks at oral health in conjunction with overall heath. In this model, KOHP, in the role of oral health consultant, could help design effective oral health guidance within this more practice and patient centered framework. We had limited success in working with our tribal communities. Although we met with the Tribal Health Directors, provided them with materials, conducted two trainings at tribal sites, and have contributed to the Tribal Health Newsletter on oral health, we were not able to establish a strong working relationship. Objective 4. Implement and coordinate trainings using the KOHP curriculum (Maine Smiles Matter) with non-dental professionals, with a focus on those providing health services to very young children, and extend training to dental providers. Summary of outcomes/accomplishments. This objective lies at the heart of KOHP. Throughout the project we promoted our training through KOHP brochure distribution at conferences and meetings and various provider newsletters. We created individualized flyers Page 4

5 Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 for each provider who sponsored a KOHP training. We also used distribution lists of medical and childcare providers, to inform them of training opportunities near them, as well including training request links in every KOHP e newsletter, every Maine Dental Access Coalition e- newsletter, and on both web sites. We also created a Facebook page for KOHP. In total we provided 64 trainings to health care providers. Some sites had multiple trainings, and some were delivered in a conference setting. In total 880 healthcare providers were trained. We provided 72 trainings to childcare, WIC and Home Visitors, reaching 876 individuals in all from this group. Trainings were conducted in 7 out of 8 public health districts 1, and a total of 1756 people received KOHP training. We did not market directly to dental providers (although over 30 dentists and dental hygienists did attend training at some point). Outreach to the dental community took place through meetings with the county dental societies, Maine Dental Association conferences and e-news. Going forward our partnership with the Dental Home Initiative (see Sustaining the Work below) will dramatically increase the involvement of dental providers in establishing dental homes. In August of 2009 we held a video conference training at 4 sites through the state for a train the trainer program. Nine people participated in learning how to deliver the KOHP curriculum. In 2011 the same training was provided to seven of the eight of Maine s network of Child Care Resource Development Centers (RDCs) which are designed to continuously identify and respond to the child care needs in the state of Maine through education, advocacy and the creation of quality child care choices. The Maine RDCs are the single point of access for parents, child care providers/programs and communities that are searching for information and direction with their child care needs, child care concerns and child care consumer education. Impact on System of Care. There is no question that the importance of young children s oral health has gained prominence in both the medical community and the childcare/family service community in Maine over the past four years, and KOHP has been an important part of making that so. Three examples illustrate this change: The Family Visitor Program now tracks and reports oral health measures in their data base, the IHOC (Improving Health Outcomes for Children) CHIPRA demonstration program in Maine collects a set of oral health indicators and will include oral health training for all participating practices, and the Head Start Dental Home Initiative was launching this in the Fall of 2011 with the full support of the Maine Dental Association and the Maine Dental Access Coalition, due to the preparatory efforts of KOHP. Lessons learned. All kinds of non-dental providers recognize the need for better knowledge and skills to support good oral health in infants and young children, and the training was regarded very favorably by those who participated. The challenge comes in knowing how well the training is incorporated into the structure of the programs and practices and if it will 1 Maine has only two Public Health Departments in the State. Within the last five years nine public health districts have been established to provide some infrastructure for public health. See for more information about the local public health districts. Page 5

6 Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 be self sustaining in the long term. Ideally there would be resources for a KOHP consultant to follow-up with sites already trained to assist with new staff, and reinforce the institutionalization of oral health practices. The KOHP trainer met five times over 2 years with a hospital-based Family Residency Practice to assist them in incorporating infant oral health into their curriculum and practice. Time and resources were not sufficient to allow this type of intensive work with many providers, but the investment in a Family Residence Practice, which will be self sustaining, was considered well worth it. Providers are challenged in fully incorporating early oral health practices. In spite of the enthusiastic response to the training we learned that not all medical practices took steps to implement a fluoride varnish protocol due a perceived lack of time, MaineCare reimbursement issues and other systemic and logistical challenges. WIC, Head Starts and Home Visitors are asked to provide guidance and instruction on a host of health related activities and fitting in oral health remains problematic. Incorporating oral health indicators in the Home Visitor data base was a huge help in this regard. We had hoped that the same could be done with WIC data tracking, but the WIC data system upgrade was delayed and we did not get this opportunity. Head Start has oral health indicators and KOHP training has prepared the staff to increase success on these through the Dental Home Initiative. There were several goals for Year Four which we were not able to meet. WIC pilot. A goal of Year Four was to identify and work with at least one WIC site to establish an on-site oral health assessment, guidance and varnish opportunity. We were unsuccessful in obtaining funding to pilot this and could not do it within existing resources. However, over the course of the project two WIC sites were trained, and a number of other WIC staff have attended training at other sites. Currently there are two WIC sites that have successfully incorporated an RDH and fluoride varnish services. Public Health Nursing. We had hoped to train state public health nurses to incorporate more oral health education and apply fluoride, but in 2010 H1N1 vaccinations took precedence over any other activity for the state s Public Health Nursing Program staff, and because there is no mechanism at this time for these nurses to be reimbursed for fluoride varnish, Public Health Nursing was not willing to commit to training during the last year of the grant period. Explore expanding District Oral Health Coordinator roles. The Maine CDC Oral Health Program created six part-time Regional Oral Health Coordinators in the school year, primarily to help coordinate school-based screening and sealant programs. KOHP had hoped to find additional funding to train these coordinators to deliver the KOHP curriculum at the Public Health District level. Objective 5. Develop and implement an evaluation component to determine use of curriculum and increased oral health visits, including the identification of a dental home. Summary of outcomes/accomplishments. The full Evaluation Report appears as an Appendix to this report, and describes its development and implementation in more detail, Page 6

7 Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 along with findings. The Evaluation Plan was developed in consultation between the evaluator and all the project principals at in the first months of the project and subsequently reviewed and discussed with the Advisory Committee. Impact on System of Care. A significant systems impact was to finally get oral health indicators incorporated into the Home Visitors database. This took far longer than originally planned because the entire database was being re-done and that project fell well behind schedule. We also established a relationship with our Medicaid agency, the Office of MaineCare Services, to receive data on claims for oral health services among children under age 3 and we have partnered with Maine s From the First Tooth to receive MaineCare data on a monthly basis on fluoride varnish claims billed to MaineCare. Lessons learned. Pre- and Post-test administration proceeded smoothly over the course of the project, although early modifications of the survey instrument meant a reduction in the number of overall numbers of tests that are perfectly comparable. An ongoing challenge was low return rate on the 4-6 month follow-up surveys. Various strategies were employed including shortening the survey, using both Survey Monkey and mail, follow-up phone calls to training sites, and drawings for incentive cash (modest) prizes. To supplement the followup surveys with health care providers, telephone interviews were conducted with key informants at individual practices. This change in the evaluation methodology provided useful qualitative information on how the KOHP training was implemented within the clinical setting. We also had hoped to be part of the WIC data base overhaul to ensure that more oral health indicators were included. This data base revision is presently on hold due to circumstances beyond our control. Objective 6. Develop and implement public health education and oral health communications components that promote early dental visits and early intervention. Summary of outcomes/accomplishments A wide variety of collaborative efforts have been undertaken over the course of the project to strengthen public health education and oral health communication. In 2008 KOHP drafted a letter for the largest medical and dental professional organizations in the state: the Maine Medical Association, the Maine Chapter of the Academy of Pediatrics, the Maine Chapter of the Academy of Family Physicians, and the Maine Dental Association, expressing unequivocal support for increased attention to early oral health care. In 2010 the Maine Primary Care Association joined as a signatory to the letter. In March of 2010 a letter was sent to every MaineCare member with children under age 4 to encourage caregivers to ask their primary care providers about fluoride varnish for their children. This was a collaborative effort with MaineCare staff and From the First Tooth and went to about 24,000 MaineCare case heads. Additionally, KOHP was instrumental in making sure that all physicians who see MaineCare children received letters explaining varnish reimbursement fees and processes. Four rounds of letters were sent over the course of the project. Page 7

8 Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 There have been several attempts to meet the need for delivering clear and consistent oral health messages for families and providers. These include a co-branding effort with From the First Tooth, exploring combining materials and initiating work with the MaineCare materials working group (a group that reviews public education materials for health literacy), and discussions with Northeast Delta Dental about a health literacy campaign for parents/caregivers of young children. None of these efforts have come to fruition thus far. Co-branding was abandoned when it became clear that KOHP would not be continuing to train medical providers after the TOHSS grant funding, but Northeast Delta Dental is still considering an oral health literacy campaign. The need for clear and consistent messages, and ways to deliver them, was brought into sharp focus in the May 2011 KOHP/Maine Dental Access Coalition conference, Oral Health for Young Children: Everybody s Business where a majority of the panels and presentations focused on aspects of oral health behaviors and communication. Impact on System of Care. There is enormous potential to impact the system of care through effective oral health communication that can facilitate behavior change at both the provider level and the caregiver level. It has not yet been fully realized. Lessons learned. The Maine Dental Association s endorsement of the Dental Home Initiative, which in effect encourages more general dentists to take children under three into their practices, even those with MaineCare or no insurance, indicates a much greater understanding and support for early intervention than existed at the beginning of this project. The need for a broad based approach to deliver clear consistent oral health messages across provider sectors has also been widely recognized, as was clearly evident at the May 2011conference. There is a readiness for a communication initiative to address early oral health needs, but there is no immediate source of funding. The need for education and training in early oral health is recognized in the provider community. The past four years have demonstrated that there is an understanding among childcare, family care and medical care providers that oral health for infants and young children is important, and that they are not equipped with the knowledge and skills to address this need. There was never a shortage of providers who wanted to avail themselves of the training provided by KOHP, and the evaluations of the content and applicability of the training were overwhelming positive. Objective 7. Enhance referral opportunities and networks. Summary of outcomes/accomplishments. KOHP has met with nine of the State s 10 regional Dental Societies, three of these meetings in conjunction with the Dental Home Initiative s state coordinator. All of these meetings included invitations to the area pediatricians and family practice offices, and all included at least one medical professional as a speaker as well as a representative from the local Head Start. In the course of these meetings we developed lists of dentists who have expressed a willingness to work with local physicians in referral agreements for young children, and dentists willing to see young children referred in other ways. This has created a starting point for a network of dentists that will be formalized within the Dental Home Initiative. Page 8

9 Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 Impact on System of Care. There have been one-on-one relationships formed between dentists and primary care providers over the course of this project. The numbers are small, and the evidence anecdotal, but it is a growing trend. The difficulty in creating and sustaining strong working relationships and referral between dental and medical providers became apparent over the course of the project. As a result, when the opportunity arose to apply for a grant from DentaQuest for an Oral Health 2014 grant the Maine Dental Access Coalition and its fiscal sponsor, Medical Care Development, were able to obtain a grant which will allow us to continue working on the challenge of medical-dental collaboration. Lessons learned. Dental-medical collaboration remains a challenge. KOHP was not able to fully facilitate the dental-medical referral relationships we envisioned at the project outset. Although the training addresses the when and how referrals should be made to dentists, there is no evidence to suggest that this happening to any great extent as a result of training. At our conference in May 2011, we actively sought to involve the medical community with some success, but not to the degree we hoped. What we were able to do is lay the ground work for further work on this important connection. At local Dental Society meetings we were able to make the case for dentists to accept younger children in their practices and to work with their medical counterparts in referrals. At the conference we were able to reinforce the importance of the dental community to engage with the medical community. Through the Dental Home Initiative we will be able to reinforce the importance of oral health referrals and involve the whole dental office staff in developing effective referrals and bringing in the support Head Start can provide in case management. III. Sustaining the Work As discussed in the lessons learned sections above, fully incorporating the knowledge, skills and abilities to include oral health in services to young children requires a cultural shift that will happen beyond the scope of KOHP. However, KOHP has been able to nudge this shift along during the grant period, and put in place a number of systemic levers that will continue to reinforce the importance of oral health for young children for non-dental providers. Childcare and family provider integration: The Maine Roads to Quality Center ( which promotes and supports professionalism in the early childcare and education field, and is responsible for the required curricula for all licensed childcare providers, has revised its curricula as a result of its work with KOHP. Caring for Infants and Toddlers revisions are complete; Health Wellness and Safety revisions are underway. Staff at seven of the eight Resource Development Centers (RDCs) funded by the Maine Department of Health and Human Services have participated in the Train the Trainer program developed by KOHP, and are able to train childcare providers interested in enhancing their center s oral health capacity. In addition, KOHP created an oral health tool box for each center containing puzzles, books, stuffed animals and work sheets relating to oral health that can be loaned out to Centers that want to incorporate oral health lessons. The availability of training and materials has been posted on the RDC Facebook page, via their newsletter and promoted through Maine s Healthy Maine Partnerships list serve. We have also provided tracking sheets for Page 9

10 Maine CDC Oral Health Program, Maine Department of Health & Human Services H47MC08655 training requests and tool box use so we can follow up next year and see if these resources have been used. Head Start has committed to improving oral care access for its children through the Dental Home Initiative (DHI) and the state DHI leader, Dr. John Willis, a pediatric dentist. Maine s DHI was developed in close collaboration with KOHP and the Maine Dental Access Coalition, and should result in significantly increasing the number of general dentists who see children under age three and low income children as well as increasing preventive visits for Head Start. As of February 2010, the Maine Families (Maine s Home Visiting Program) data collection system now includes oral health indicators. This ensures that guidance on children s oral health will continue to be provided by home visitors across the state and data will be collected to track the impact of the home visitors efforts. Medical provider integration: Maine has the good fortune of having a privately funded initiative, From the First Tooth (FTFT), ( training medical practices to incorporate fluoride varnish. As of August 2011 KOHP notified all practices that had received KOHP training, and referred any that had made inquires for training, to From the First Tooth for training and technical assistance. FTFT is also developing a Best Practices manual for medical practices that incorporate fluoride varnish application. A yearlong collaboration with the Central Maine Medical Center Family Residency Program and KOHP resulted in oral health and varnish application being permanently included within this residency training program for family practitioners. Because the Family Practice Residency worked through a variety of institutional issues with KOHP s help, the Central Maine Medical Center Pediatric Practice has expressed renewed interest in incorporating oral health in its program, which From the First Tooth will be in a position to support. Maine is also home to a CHIPRA demonstration project, Improving Health Outcomes for Children (IHOC) and KOHP is represented on the Steering Committee. The project has developed a list of pediatric core measures which include five relating to oral health. Three of these (percent of children with oral health risk assessment completed between ages 6 months and 4 years; percent of children with dental homes by year one and annual documentation until year 4; and percent of children receiving fluoride varnish) will be tracked in the electronic medical records of the four Pediatric Patient Centered Medical Home sites. Two other measures are being tracked through MaineCare claims; these are the total number of eligible s receiving preventive dental services, and total EPSDT eligible children receiving dental treatment. The Maine Dental Access Coalition has fully embraced early child oral health as a top priority; in fact, the Maine Smiles Matter curriculum was developed by the Coalition and provided the foundation for the Kids Oral Health Partnership. To the extent the Coalition continues to grow and extend its influence in policy, advocacy and help launch projects such as the Dental Home Initiative, there will be support for the systemic changes that support assessment, guidance, preventive measures and fluoride varnish for infants and young children. Page 10

11 Maine s KOHP Evaluation Attachments 1. Healthcare provider pretest survey 2. Healthcare provider posttest survey 3. Healthcare provider follow up interview questions 4. Early childhood professional pretest survey 5. Early childhood professional posttest survey 6. Early childhood professional follow up survey 7. Maine Families (home visiting) Oral Health Questions

12 Kids Oral Health Partnership Pre-Training Questionnaire for Healthcare Providers Thank you for participating in the Kids Oral Health Partnership Pilot. This form will help us to evaluate the training program and your assistance with this component of the program is greatly appreciated. Please complete the following Identifier Code. This is a number we can use to match your responses with subsequent assessments. We will only use this number to compare responses to these questions. The number will not be used to determine the identity of any individual. Number of siblings Last 2 digits of home phone # Last 3 digits of zip code What is your profession? Please respond to the questions below by checking the appropriate box. Physician RN Other Physician Assistant Medical Student Please specify: Nurse Practitioner Medical Assistant Prior to this training, how often did you (or another professional in your practice) ordinarily do the following relative to pregnant patients? Routinely refer pregnant patients to a dentist/ask if they have one. Coordinate care or consult with a pregnant patient s dental provider. Not applicable (don t see pregnant patients) Never or almost never Occasionally Always or almost always Prior to this training, how often did you (or another professional in your practice) ordinarily do the following relative to children age 0 to 3? (Note: 0-3 includes the prenatal period) Look for evidence of decay by lifting child s lip when checking the mouth. Inquire about the oral health of the child s mother or caregiver. Coordinate care or consult with a child s dental provider. Not applicable (don t see children under age 3) Never or almost never Occasionally Always or almost always As part of your regular practice, do you refer infant and children under age 3 for dental care? Yes, routinely Yes, sometimes No (why not? ) KOHP Questionnaire for Health Providers Pre Test September_08 1

13 If YES, you refer young children for dental care, at what age do you typically refer them to a dentist? (check only one) NA-I don t refer children under age 3 to a dentist 1 yr 2 yrs 3yrs 4 yrs 5 yrs 6 yrs 7 yrs 8 yrs What is your experience in finding a local dentist who will see a child Less than 3 years of age. NA-Have not needed to refer someone from this population Not at all difficult Somewhat difficult Difficult Extremely difficult Less than 3 years old with a disability or other special needs. Less than 3 years old who receives MaineCare, is uninsured, or underinsured. How often do you discuss these things during your visits with caregivers who have children 0 to 3? Never Rarely Sometimes Often Always Giving a baby a bottle when the baby is in a bed/crib, or when the baby might by lying down or falling asleep. Cleaning infant/children s teeth Using fluoride toothpaste with children Using fluoride rinse or tablets Checking well water for fluoride The age at which a child should begin to see a dentist Giving a baby a sippy cup when the baby is in bed/crib Cleaning the gums of infants Applying fluoride varnish Drinking fluoridated water through the public water supply KOHP Questionnaire for Health Providers Pre Test September_08 2

14 How confident are you that you can Not at all confident Not very confident Somewhat confident Very confident Completely confident Recognize baby bottle tooth decay. Evaluate a child s risk of having dental disease sometime in the future. Advise parents about their child s oral hygiene. Make dietary recommendations to prevent early childhood tooth decay. Determine clients possible fluoride sources. Advise parents about the use of fluoride supplements during infancy or childhood. Advise parents about dental visits for their child. Make a dental referral for a child or infant. Advise parents about the use of fluoride toothpaste. Please check the box indicating whether the statement is true or false. Primary (baby) tooth development begins during the final trimester. Permanent tooth development begins at age 2. Dental caries (decay) is a bacterial infection. Snacks such as potato chips and pretzels are not harmful to teeth and should be encourage instead of candy. It is ok to clean a pacifier by placing it in the caregiver s mouth before placing it in the child s mouth. It is ok to help a baby fall sleep using a bottle of milk, formula or juice. Children do not need a dental exam until their permanent teeth come in. Breastfeeding is associated with lower rates of tooth decay than bottle feeding. Flossing should begin whenever two teeth touch. A pea-sized amount/smear of fluoridated tooth paste should be used starting at age 2. Caregivers should wipe gums with a soft cloth starting at birth. Community water fluoridation is the most effective method of reducing tooth decay KOHP Questionnaire for Health Providers Pre Test September_08 3

15 Severity of oral diseases progression may be faster in children with special healthcare needs Pregnant women should wait until after they give birth to see dentist. Putting a child to bed with a sippy cup of milk, formula or juice will not harm their teeth. By two years of age, a child should be brushing his or her teeth unassisted. Decay is not important in young children because the baby teeth will fall out soon. Research indicates xylitol gum reduces the number of bacteria transferred between caregivers and infants. Chalky white spots on a child s teeth can be remineralized with fluoride varnish. An adult has to help children brush their teeth until about the age of 8 years old. Please select only one answer to the questions below. 1. Lifting the lip A. Can help health professional and caregivers to brush teeth more effectively. B. Can help children get more comfortable with a visit to the dentist. C. Should only be done by dental professionals D. A and B. E. B and C. 2. If a child has a dental home, it means: A. The child sees a dentist on a regular basis. B. The child has a primary care provider/physician who provides education and examines the child s teeth on a regular basis. C. The child has oral health assessments through HeadStart or other child care setting on a regular basis. D. Any of the above. E. None of the above 3. Which of the following is not true about caries infection? A. If one child in a family has caries, all children will get caries. B. Cariogenic bacteria are transmitted from mother/primary caregiver to child. C. Streptococcus mutans is the most common infecting agent. D. The bacteria causing tooth decay can be transmitted from caregiver to child through contact such as sharing spoons or cleaning a pacifier with caregiver saliva. E. The earlier the child is colonized with cariogenic bacteria, the higher the risk of caries. KOHP Questionnaire for Health Providers Pre Test September_08 4

16 Kids Oral Health Partnership Post Training Questionnaire for Healthcare Providers Thank you for participating in the Kids Oral Health Partnership. This form will help us to evaluate the training program and your assistance with this component of the program is greatly appreciated. Please complete the following Identifier Code. This is a number we can use to match your responses with subsequent assessments. We will only use this number to compare responses to these questions. The number will not be used to determine the identity of any individual. Number of siblings Last 2 digits of home phone # Last 3 digits of zip code Please respond to the questions below by checking the appropriate box. Overall, how satisfied are you with this learning experience? Very Satisfied Satisfied Neutral Dissatisfied Very Dissatisfied How do you rate the value to you of this learning experience in terms of: Relevance to your learning needs / competency gaps Providing knowledge, skills & tools you can use in your work Likelihood that you would recommend it to others Excellent Good Fair Poor What is your assessment of this learning experience with regard to: Length Comprehensiveness (breadth and depth) of the content Variety of learning activities Use of work related examples Amount of time available for questions Less than needed About right More than needed Before today, had you ever received training in infant/child oral health? Yes No If Yes --you have received training on oral health care for children--when was your most recent training (please circle one below)? a. Within the past 12 months b. 1-3 years ago c. More than 3 years ago KOHP Questionnaire for Health Providers Post Training September_08 1

17 What areas would you have liked to have received more training on? The importance of early oral health care Understanding of the disease process and transmission Parent Education Prenatal oral health care Children with Special Health Care Needs Child oral health assessment Cultural competency and oral health Other (please specify): Other (please specify): None, all areas were covered to my satisfaction. As a result of this training, how confident are you that you can Not at all confident Not very confident Somewhat confident Very Confident Completely confident Recognize baby bottle tooth decay. Evaluate a child s risk of having dental disease sometime in the future. Advise parents about their child s oral hygiene. Make dietary recommendations to prevent early childhood tooth decay. Determine clients possible fluoride sources. Advise parents about the use of fluoride supplements during infancy or childhood. Advise parents about dental visits for their child. Make a dental referral for a child or infant. Advise parents about the use of fluoride toothpaste. As a result of this training, in the future how likely will you be to Very Unlikely Unlikely Somewhat unlikely Somewhat likely Likely Discuss oral health on a regular basis with your patients and/or their caregivers. Conduct oral health assessments on children under age 3. Refer patients under age 3 to local dentists if needed. Connect with dentists in your area that accept children under age 3 as patients. Please check the box indicating whether the following statements are true or false. Primary (baby) tooth development begins during the final trimester. Permanent tooth development begins at age 2. KOHP Questionnaire for Health Providers Post Training September_08 2

18 Dental caries (decay) is a bacterial infection. Snacks such as potato chips and pretzels are not harmful to teeth and should be encourage instead of candy. It is ok to clean a pacifier by placing it in the caregiver s mouth before placing it in the child s mouth. It is ok to help a baby fall sleep using a bottle of milk, formula or juice. Children do not need a dental exam until their permanent teeth come in. Breastfeeding is associated with lower rates of tooth decay than bottle feeding. Flossing should begin whenever two teeth touch. A pea-sized amount/smear of fluoridated tooth paste should be used starting at age 2. Caregivers should wipe gums with a soft cloth starting at birth. Community water fluoridation is the most effective method of reducing tooth decay Severity of oral diseases progression may be faster in children with special healthcare needs Pregnant women should wait until after they give birth to see dentist. Putting a child to bed with a sippy cup of milk, formula or juice will not harm their teeth. By two years of age, a child should be brushing his or her teeth unassisted. Decay is not important in young children because the baby teeth will fall out soon. Research indicates xylitol gum reduces the number of bacteria transferred between caregivers and infants. Chalky white spots on a child s teeth can be remineralized with fluoride varnish. An adult has to help children brush their teeth until about the age of 8 years old. KOHP Questionnaire for Health Providers Post Training September_08 3

19 Please select only one answer to the questions below. 1. Lifting the lip A. Can help health professional and caregivers to brush teeth more effectively. B. Can help children get more comfortable with a visit to the dentist. C. Should only be done by dental professionals D. A and B. E. B and C. 2. If a child has a dental home, it means: A. The child sees a dentist on a regular basis. B. The child has a primary care provider/physician who provides education and examines the child s teeth on a regular basis. C. The child has oral health assessments through HeadStart or other child care setting on a regular basis. D. Any of the above. E. None of the above 3. Which of the following is not true about caries infection? A. If one child in a family has caries, all children will get caries. B. Cariogenic bacteria are transmitted from mother/primary caregiver to child. C. Streptococcus mutans is the most common infecting agent. D. The bacteria causing tooth decay can be transmitted from caregiver to child through contact such as sharing spoons or cleaning a pacifier with caregiver saliva. E. The earlier the child is colonized with cariogenic bacteria, the higher the risk of caries. Additional comments: THANK YOU! KOHP Questionnaire for Health Providers Post Training September_08 4

20 Kids Oral Health Partnership DRAFT Telephone interview questions for non-dental health care providers 1. Can you please tell me about your patient panel/population? a. What percent of your patients are under age 5 (approximately)? b. What percent of your patients are enrolled in Medicaid? c. What is the racial/ethnic distribution of your patient population? d. Approximately what percent of your patients or the caregivers of your patients speak a language other than English as their primary language? e. What percent of your population are from rural locations? (Would you describe your patient population as largely rural?) f. What percentage of your patient population are children with disabilities or other special health care need? 2. Based on a scale from 1-3 (1=never, 2=occasionally, 3=always or almost always), since the training, can you tell how frequently do (you/staff in your practice): a. Conduct an oral health risk assessment as taught in the training? 1 (Never) 2 (Occasionally) 3 (Always or almost always) b. Apply fluoride varnish? 1 (Never) 2 (Occasionally) 3 (Always or almost always)

21 c. Provide parental education or guidance to parents/caregivers? (documentation in EMRs, or brochures) 1 (Never) 2 (Occasionally) 3 (Always or almost always) 3. How has the training changed clinical practices around preventive oral health care for young children among your providers? Routine screening Fluoride varnish Guidance for parents Materials purchased/obtained Additional Training Other

22 4. Have you changed any specific office protocols after the training? Formalized mechanism for referrals for urgent dental care On health records Increased use of billing code for fluoride varnish Purchase of fluoride varnish Fluoride varnish in all exam rooms Contact with local dental providers (if so, any challenges) Other 5. How are referrals for urgent dental care currently handled in your office? Are they part of the medical record? Has anything in your referral process for urgent dental care changed since the training? Possible successful stories? Can you tell me about a time that you were successful in obtaining care for one of your patients or had a family appreciate the oral health care/fluoride varnish given by your practice? 6. Do you have electronic medical records or paper records?

23 7. Do your EMRs/medical records include oral health risk assessment and/or fluoride varnish administration on them? i. If yes, was this a result of the training or did your EMR/medical records contain this information previously? (if on previously, do they notice an increase in recording this information in charts?) ii. if no, do you anticipate this information will be added to your EMR/medical records? What are some challenges or barriers to including this on your EMR/medical records? 8. Since the training, what challenges or barriers do you/your practice continue to face when addressing oral health with young children? Did anything change after the training? (examples include: time, funding/ability to bill, lack of community dentists, parental resistance). Time with patients Lack of funding/inability to bill Lack of community dentists Parental resistance Staff not comfortable doing fluoride varnish Difficult to integrate into current practice Other

24 Why? 9. What was the most useful part of the training? Which part(s) stuck? Oral assessment training Fluoride varnish application training Parental education All None 10. We are in the midst of planning for the last year of the grant. Do you have any ideas on how the training could be improved? Would it be helpful if Bonnie came back to conduct another training with your practice? If so, are there any topics that you would like more information on? 11. As I mentioned we are in the last year of this project and we are thinking a lot about sustainability and how to continue the momentum of this project. In your opinion, what do you think it would take for non-dental health care providers in Maine to provide preventive oral health services on a regular and ongoing basis? In

25 other words, how can we get more practices to embrace and institutionalize prevention of oral health problems among young children? Physician champion Peer-to-peer trainings/presentation Ongoing training Insurance company funding Other 12. You mentioned that a large proportion of your population are.(cshn, refugees, rural, ESL)? What do you see are the challenges around oral health that this population faces? Did the training provide you with any support or information to assist you when working with diverse populations? Can you think of any ways that the Kids Oral Health Partnership could assist you in your work around oral health in diverse populations?

26 Kids Oral Health Partnership Pre-Training Questionnaire for Home Visitors and Child Care Providers Thank you for participating in the Kids Oral Health Partnership. This form will help us to evaluate the training program and your assistance with this component of the program is greatly appreciated. Please complete the following Identifier Code. This is a number we can use to match your responses with subsequent assessments. We will only use this number to compare responses to these questions. The number will not be used to determine the identity of any individual. Number of siblings Last 2 digits of home phone # Last 3 digits of zip code Please circle your affiliation: a. Maine Home Visiting (Healthy Families/Parents are Teachers/Parents are Teachers Too) b. Head Start c. Other Child Care Provider d. Other (please specify): Please respond to the questions below by checking the appropriate box. How often do you discuss these things with caregivers who have children 0 to 3? Never Rarely Sometimes Often Always Giving a baby a bottle when the baby is in a bed/crib, or when the baby might by lying down or falling asleep Cleaning infant/children s teeth Using fluoride toothpaste with children Using fluoride rinse or tablets Checking well water for fluoride The age at which a child should begin to see a dentist Giving a baby a sippy cup when the baby is in bed/crib Cleaning the gums of infants Applying fluoride varnish Drinking fluoridated water through the public water supply In the past 6 months, how often have you discussed the importance of maternal dental care with your pregnant clients? NA- I don t work with pregnant women Never Rarely Sometimes Often Always KOHP Questionnaire for Home Visitors and Child Care Providers Pre Test September_08 1